Acupuncture improves quality of life for breast cancer patients using aromatase inhibitors

Use of electroacupuncture (EA) – a form of acupuncture where a small electric current is passed between pairs of acupuncture needles – produces significant improvements in fatigue, anxiety and depression in as little as eight weeks for early stage breast cancer patients experiencing joint pain related to the use of aromatase inhibitors (AIs) to treat breast cancer.

The results of a randomized, placebo-controlled trial examining the intervention led by researchers at the Perelman School of Medicine at the University of Pennsylvania are published online this week in the journal Cancer. The study is the first demonstration of EA's efficacy for both joint pain relief, as well as these other common symptoms.

Despite their efficacy, the joint pain associated with the use of AIs often leads to fatigue, anxiety, depression, and sleep disturbances for these patients, which researchers suggest may cause premature discontinuation of the drug. Previous studies have shown that nearly half of women taking AIs do not complete their recommended course of treatment, and that those who stop taking the drugs or don't take them as prescribed have a higher chance of dying of both breast cancer and other causes.

"Since many patients experience pain, fatigue, anxiety and depression simultaneously, our results provide an opportunity to offer patients one treatment that may target multiple symptoms," said lead author Jun Mao, MD MSCE, associate professor of Family Medicine and Community Health in Penn's Perelman School of Medicine, who directs the Integrative Oncology program in the Abramson Cancer Center.

"We see patients every day who are looking for ways to combat some of the side effects of their treatment. What is particularly significant about these new results is that we can now offer more evidence-based treatment and management solutions for these women."

In the eight-week trial, researchers evaluated the short-term effects and safety of EA for AI-related joint pain and other side effects, compared with sham acupuncture (SA – a non-electric, placebo acupuncture where the needles are not actually inserted into the skin), and usual care.

The study participants, who were all receiving AI therapy and experiencing joint pain, were randomly assigned to receive EA, SA or usual care. Patient-reported experiences of fatigue and psychological distress, were measured prior to the study, and periodically throughout the duration, with additional follow-up four weeks after treatment.

Fatigue: Compared with usual care, patients receiving EA had a greater reduction in the fatigue score at week eight and the effect was maintained at week 12. On average, patients reported a 2.0 point reduction in fatigue on the Brief Fatigue Inventory, an instrument designed to assess fatigue severity on a numerical scale ranging from 0-10.

Anxiety: By week 12, patients receiving EA reported a significant improvement in their anxiety score, whereas patients receiving SA did not. On average, patients in the EA group reported a 2.2 point reduction in anxiety on the Hospital Anxiety and Depression Scale (HADS) compared to the usual care group.

Depression: Patients in both EA and SA groups reported a significant improvement in HADS-Depression scores (2.4 points and 2.0 points, respectively) compared with the usual care group by week eight. The effects of both EA and SA on depression were maintained at week 12.

"Our study provides a novel understanding of how fatigue, sleep and psychological distress relate to pain in patients with AI-related joint pain. More importantly, we found that acupuncture helped reduce these symptoms and the effects persisted for at least four weeks following treatment," said Mao. "There is a small but growing body of literature showing that acupuncture is effective for the management of pain, fatigue, anxiety and depression. However, studies with larger sample sizes and longer follow-up periods are needed to provide more in-depth knowledge about how these treatments, combined with usual care, are improving quality of life for our patients."

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In addition to Mao, other Penn authors on the study are John Farrar, MD, PhD, Angela DeMichele, MD, MSCE, Sharon Xie, PhD, Jarcy Zee, and Christina Seluzicki. The study was supported with grants from the National Institutes of Health (R21 AT004695, K23 AT004112).

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community.